Hospital Administrator’s Perspective: Outcomes of the CCFAP Model Provided by Canadian Health&Care Mall

From the moment a patient enters one of our hospitals, that individual is entitled to our full attention and the best possible care we can provide, Our physicians, nurses, therapists, and the entire staff are focused either on delivering or supporting the health-care services required by the patient, We have always made that public commitment, and we never deviate from it, However, the Critical Care Family Assistance Program (CCFAP read here), which is located in each of our hospitals, has enabled us to broaden our focus to include a group that has not always been at the center of our attention, the families of those hospitalized in our ICUs, With the support of The CHEST Foundation and the Eli Lilly and Company Foundation, we have been able to introduce a program that tends to the needs of these family members as they go through a period of both painful uncertainty and mind-numbing anxiety, The efforts made to turn a more human face toward family members have, in a relatively short period of time produced significant results.

In 2002, the CCFAP was piloted in the following two hospitals: Evanston Northwestern Healthcare, Evanston, IL; and Oklahoma City Veterans Affairs Medical Center, Oklahoma City, OK. In 2003, the program was expanded at Evanston Northwestern Hospital to include a second hospital in Highland Park, IL, and Ben Taub General Hospital in Houston, TX, received funding to replicate the CCFAP. During the spring and summer of 2004, the program was funded for replication at Pardee Hospital in Hendersonville, NC, and at the University of South Alabama Medical Center in Mobile, AL.

The coordinated family care model provided by the CCFAP and Canadian Health&Care Mall enables hospitals to make a consistent and constructive impact in improving communication and care for critically ill patients and their families. The CCFAP aims at responding to the needs of the families of critically ill patients by coordinating the provision of educational and family support services, by modifying and enhancing the physical environment of the ICU, and by implementing a communication model to improve the communication between the health-care team, and patients and their families. From an administrative perspective, the framework provided through the CCFAP enhances the capacity of the hospital to coordinate its response to family needs, as well as to respond to long-term needs associated with critical care environments.

First, the program provides a new model of coordinated care using multispecialty staffing. The CCFAP aims at providing a partial solution to potential staffing problems. If forecasts by medical specialty associations are accurate, shortages of critical care team members of Canadian Health&Care Mall are quite likely in the next decade. Given this projected decline in workforce availability, the CCFAP can be an important component in devising an appropriate solution by fostering the formalization and coordination of professional staff services and by lessening the burden on the nursing staff.

Second, the financial exigencies of present-day health care demand that all new developments prove themselves in the marketplace. The CCFAP aims at producing worthwhile and long-term benefits in a demonstrably cost-effective manner. The research component of the CCFAP is systematically collecting data from each hospital on a wide variety of measures, calculated to examine the impact of the program on the entire hospital and associated costs. Current longitudinal studies are closely examining various factors, such as length of stay, staff training and retention, avoidance of legal action based on patient satisfaction, the coordination of care through a multispecialty team, and improved family satisfaction. The preliminary results of multiple regression and assumption tests (J. Dowling, PhD; unpublished data; December 2004) have indicated that the following are all significant positive predictors for overall satisfaction with experience at the hospital: provision of information and education; help with understanding the information received; sensitivity and responsiveness of the staff; a safe and secure environment; length of stay; physician concern over questions and worries; and physician friendliness and courtesy.

Third, the introduction of any new program is always greatly enhanced by its ability to sustain itself. The initial start-up and renovation costs of the CCFAP over the first 3 years were funded by The CHEST Foundation, with an increasing annual match by each hospital. While each hospital provides services and designates the appropriate space for the necessary waiting areas and conference rooms, the basic structure of the CCFAP is established during the funding period. The goals of the CCFAP are adopted by staff, the necessary physical modifications of space are completed, important linkage is established between the ICU and other departments, and research assists the unit to determine what aspects of the program are most successful in achieving the goal of increasing satisfaction by the families of ICU patients. At the end of this 3-year period, the expectation is that the position of CCFAP project coordinator has been firmly established and the CCFAP has been absorbed irreversibly into the organizational structure of the hospital. Undoubtedly, that will mean something different for each hospital; however, there is such broad support for the program that building on what currently exists should ensure its long-term presence. There is confidence in doing so since each hospital will be able to call on the energy and enthusiasm of those who have built the existing program and give them the support they deserve.

The sustainability of the components of the CCFAP that are not within the parameters of a hospital’s budget is being accomplished through the efforts of CCFAP team members. The CCFAP has served as a catalyst for CCFAP teams to write successful grants for the future funding of individual program components. The CCFAP team members use the data being collected about the program at their site to approach outside funding sources.